To critically review the past years of research on paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections in children and adolescents.Literature on PANDAS published from 1995 onward was systematically reviewed. The review focuses on definition and diagnostic consideration aetiological and therapeutical issues. To illustrate the clinical characteristic of PANDAS authors present two cases of children with a severe course of obsessive-compulsive disorder and Tourette's syndrome.Post-streptococcal autoimmunity has been postulated as an aetiologic factor in the development of childhood-onset obsessive-compulsive disorder, tic disorders including Tourette's disorder. This hypothesis arose from a series of clinical observations including the documentation of obsessive-compulsive symptoms of children affected by Sydenham's chorea, a variant of rheumatic fever characterised by neurological dysfunction and also by concomitant investigations of childhood-onset OCD and Tourette's syndrome.Results of these studies led to the identification of children whose clinical course is characterised by abrupt and dramatic symptom exacerbations which are temporally related to group A beta-hemolytic streptococcal infections. The identification of such a subgroup will allow for testing of the model of pathogenesis as well as development of novel treatment and prevention strategies. Future research are needed to explore the nature of PANDAS and their relationship with different psychiatric disorders in children and adolescents.
The aim of this study was to establish the attitudes of enuretic children towards their illness and to assess the correlation between children's attitudes and biological and medical variables describing the clinical picture and course of enuresis. Fifty children were included (31M, 19F), aged 8–18 y (mean 12.74 y), all with the diagnosis of enuresis. The reference groups consisted of 60 children with asthma and 40 children with chronic heart disease, aged 8—12 y. The Polish version of the Child Attitude Toward Illness Scale (CATIS) was administered to all the children and structured interviews concerning demographic and medical data were conducted with the parents. There were no significant differences in median CATIS scores between the subgroups divided according to age, type of enuresis and family history of enuresis. There was no significant correlation between the CATIS score and frequency of enuresis and number of therapeutic failures. The girls had significantly lower median CATIS scores than the boys ( p = 0.03). The difference in median CATIS scores between genders was significant only for the older group aged 14–18 y. The older girls had the lowest CATIS scores. Enuretic children were found to have statistically significantly more negative attitudes towards their illness than children with asthma ( p = 0.006) and children with chronic heart disease ( p = 0.067). Conclusion : Enuretic children had more negative feelings about their illness than children with other chronic conditions. This negative attitude was not related to demographic or clinical data except for gender. The adolescent girls demonstrated the most negative attitude towards enuresis.
Population studies indicate a strong relationship between birth weight (BW) and body size in later life. However, BW as a variable was never accounted for in studies on the relationship between attention-deficit/hyperactivity disorder (ADHD) and overweight. This study aims to assess the relationship between ADHD and overweight with control of birth weight and other confounding factors. Prevalence of overweight was compared in clinical sample of 219 boys with ADHD and 396 boys without ADHD, aged 6–18 years. The following factors were controlled: BW, parents income and education level, place of residence, ADHD type, selected comorbid disorders and stimulant treatment. Overweight and obesity were diagnosed according to the criteria proposed by the International Obesity Task Force. Logistic regression analysis was used to estimate the association between ADHD and the prevalence of overweight and obesity. Boys with ADHD differed significantly from the control group in distribution of low BW (8.2 vs. 3.0 %, χ 2 = 8.23, p = 0.02). Low BW was associated with a lower prevalence of overweight than normal and high BW (0 vs. 12.14 %, χ 2 = 4.12, p = 0.04). Overweight was observed significantly more often in boys with ADHD (17.3 vs. 8.3 %, χ 2 = 11.23, p < 0.001) even after adjustment for BW and other variables (OR = 2.44, 95 % CI 1.38–4.29, p = 0.002) and after controlling for ADHD type, stimulant treatment and selected comorbid disorders. Independently to applied analysis, obesity was not associated with ADHD. Lower birth weight is over twice more often observed in boys with ADHD than in control group. Although this phenomenon may reduce the rate of overweight in the studied group, ADHD remains strongly associated with increased prevalence of overweight.
Oddajemy w ręce czytelników wyjątkową książkę pt. „Psychofarmakologia kliniczna”. Autorzy omówili w niej zastosowanie środków farmakologicznych w leczeniu zaburzeń psychicznych. Publikacja została przygotowana przez wybitnych polskich specjalistów – psychiatrów, farmakologów i neurobiologów. Jest to ważna premiera na rynku wydawniczym. „Psychofarmakologia kliniczna” to prawie 900 stron rzetelnej, ciekawej wiedzy przekazanej przez uznane autorytety w swoich dziedzinach. Książka jest skierowana do lekarzy specjalistów – psychiatrów, neurologów, seksuologów, neurobiologów, farmakologów, a także osób przygotowujących się do egzaminu specjalizacyjnego w wybranych gałęziach medycyny. Zainteresuje również psychoterapeutów pracujących w zespołach interdyscyplinarnych.
Background Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry , 28 , 1107) found that much more variance in 72,493 parents’ ratings of their offspring’s mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents’ reports are essential for clinical assessment of their offspring, they reflect parents’ perceptions of the offspring. Consequently, clinical assessment also requires self‐reports from the offspring themselves. To test effects of individual differences, society, and culture on youths’ self‐ratings of their problems and strengths, we analyzed Youth Self‐Report (YSR) scores for 39,849 11–17 year olds in 38 societies. Methods Indigenous researchers obtained YSR self‐ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects. Results Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects. Conclusions Like parents’ ratings, youths’ self‐ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self‐rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths’ self‐reports should thus not be minimized by societal/cultural differences, which—while important—can be taken into account with appropriate norms, as can gender and age differences.
Aripiprazole, cariprazine and brexpiprazole are antipsychotic drugs (APD) whose action is associated with partial agonism at the dopamine D2/D3 receptors. They are increasingly more widely used in clinical practice, also off-label. The aim of this article is to present the current state of knowledge on the use of these drugs in the treatment of mental disorders. The position statement was developed by the panel of experts appointedby the Executive Board of the Polish Psychiatric Association, consisting of individuals with many years of experience in treating patients with mental disorders. The evaluation included the analysis of literature databases (Medline, Embase, Cochrane) and information obtained from metaanalyses and summaries of product characteristics. A key property of D2/D3 partial agonists is that they display diverse effects on dopamine pathways: (a) blockade of mesolimbic signalling that is overactive in the acute phase of schizophrenia and mania, (b) stimulation of mesocortical pathways with an improvement (or at least with no deterioration) of cognitive functions and negative symptoms, (c) no blockade of the tuberoinfundibular pathway and, consequently, low risk of increased prolactin secretion, (d) no blockade of nigrostriatal pathway and, consequently, low risk of extrapyramidal symptoms. Selective profile of action and intrinsic activity at dopamine D2 (aripiprazole > brexpiprazole) and D3 (cariprazine) receptors in combination with the lack of antihistamine and anticholinergic properties make aripiprazole, brexpiprazole and cariprazine different form other APD in terms of their safety and tolerability. This is the reason for the increasing use of these drugs in the treatment of schizophrenia and mood disorders, and in the case of aripiprazole also in obsessive-compulsive, autism-spectrum and tic disorders.
To compare the self concept of boys with ADHD and health subjects; to determine which symptoms ofADHD, oppositional defiant disorder (ODD) or conduct disorder (CD) have the greatest impact on self-concept.Polish version of The Harter Self-Esteem Questionnaire (HSEQ) was filled by boys with ADHD and control group. In addition, a diagnosis of ODD and CD was made in ADHD group.A significant difference was observed between boys with ADHD and control group on the following scales of HSEQ: Global Self-Esteem Subscale, Social Acceptance Subscale and Scholastic Performance Subscale. No significant influence of the quantity and intensity of ADHD and ODD symptoms on self-esteem was found. A significant correlation was indicated between all scales of HSEQ and quantity and intensity of symptoms ofADHD.Boys with ADHD have lower self-esteem than their healthy peers and their global self-esteem, social acceptance and school skills are most affected. The presence of conduct disorder (CD) had the greatest impact on the decrease of self esteem in ADHD group.
The main aim of the European Study SPOKE (Sanofi-Synthelabo Programme for Outcome Knowledge of Epilepsy) designed by the Department of Neurosciences, Walton Hospital in Liverpool and the Centre for Health Services Research at the University of Newcastle upon Tyne, England, was to describe levels of knowledge about epilepsy among people with epilepsy and their families. It was equally important to identify gaps in understanding the most important aspects of the illness as well as to identify characteristics of people who score poorly on the Epilepsy Knowledge Questionnaire (EKQ). Another aim was to consider the implications of identified gaps in knowledge for future educational and psychosocial interventions.The study was conducted in 10 European countries and included 6156 people with epilepsy and 6506 members of their families. Results presented here relate to data for Poland only, where the examined population consisted of 1028 patients with epilepsy. 1033 questionnaires were returned by carers.Over 40% of all respondents had frequent seizures, and one third were seizure free. Scores on the Epilepsy Knowledge Questionnaire were high for the majority of respondents, but generally lower than in most of the countries. With reference to some aspects of illness important gaps in knowledge have been demonstrated. For example, it was shown that a significant number of respondents provided incorrect answers to questions relating to aspects of the etiology of epilepsy and administration of antiepileptic drug medication. There were a number of significant differences between the profiles of high and low scorers on the EKQ; high scorers were likely to have spent longer on education, have lower scores on the impact of epilepsy scale and report better adjustment to their epilepsy.The results of the study once again underline the importance of continued information among patients with epilepsy and their families in order to achieve.
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